Advertisement

Roux-en-Y Gastric Bypass Reversal for Severe Malnutrition and Cirrhosis

  • N. Beghdadi
  • A. Soprani
  • A. Kraemer
  • P. Bucur
  • C. Barrat
  • L. GenserEmail author
Video Submission

Abstract

Background

Severe post-operative malnutrition (SM) is a dreaded complication after gastric bypass often related to the short bowel syndrome consecutive limb length mismeasurement or intestinal resections. Patients with rapid weight loss or malnutrition can experience liver failure with cirrhosis and require liver transplantation (LT). Malnutrition can constitute a contraindication to LT since it negatively impacts on postoperative morbidity. RYGB reversal is an effective option to consider when nutritional support has failed. We describe the performance of a RYGB reversal in a pre-LT setting.

Material and Methods

A 36-year-old patient with morbid obesity (weight, 140 kg; BMI, 50.1 kg/m2) underwent a RYGB 9 years ago. She presented with 85 kg weight loss (i.e., 60.7% total body weight loss) associated with SM and hepatocellular insufficiency. LT was considered but contraindicated because of SM. An intensive nutritional support was attempted but failed and the RYGB reversal was recommended.

Results

Laparoscopic exploration revealed ascites, cirrhosis, and splenomegaly. The whole small bowel measurement revealed a short gut. Alimentary, biliary, and common channel limb lengths were 250 cm, 150 cm, and 30 cm long. The alimentary limb was stapled off the gastric pouch and the gastrojejunostomy was resected. After resection of the gastrojejunostomy, linear stappled gastro-gastrostomy and jéjuno-jejunostomy were performed to restore the normal anatomy. At 1 year, malnutrition was resolved and the cirrhosis was stabilized.

Conclusion

Reversal to normal anatomy appeared effective and safe in this setting but must be considered only after failure of intensive medical management. Careful bowel measurement is mandatory to prevent patients from this complication.

Keywords

Bypass Reversal Malnutrition Cirrhosis Liver 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

For this type of study, formal consent is not required.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11695_2019_3770_MOESM1_ESM.mp4 (166.9 mb)
ESM 1 (MP4 170865 kb)

References

  1. 1.
    Schauer DP, Feigelson HS, Koebnick C, et al. Bariatric surgery and the risk of cancer in a large multisite cohort. Ann Surg. 2017.Google Scholar
  2. 2.
    Bétry C, Disse E, Chambrier C, et al. Need for intensive nutrition care after bariatric surgery: is mini gastric bypass at fault? JPEN J Parenter Enteral Nutr. 2016.Google Scholar
  3. 3.
    Genser L, Soprani A, Tabbara M, et al. Laparoscopic reversal of mini-gastric bypass to original anatomy for severe postoperative malnutrition. Langenbeck’s Arch Surg. 2017;402:1263–70.CrossRefGoogle Scholar
  4. 4.
    Pernar LIM, Kim JJ, Shikora SA. Gastric bypass reversal - a 7-year experience. Surg Obes Relat Dis. 2016 [cited 2016 Apr 28];0. Available from: http://www.soard.org/article/S1550728916300302/abstract
  5. 5.
    Caiazzo R, Lassailly G, Leteurtre E, et al. Rouxen-Y gastric bypass versus adjustable gastric banding to reduce nonalcoholic fatty liver disease: a 5-year controlled longitudinal study. Ann Surg. 2014;260:893–9.CrossRefGoogle Scholar
  6. 6.
    Mahawar KK. Liver dysfunction with both Roux-en-Y and one-anastomosis gastric bypass is almost exclusively seen with longer than standard limb lengths. Obes Surg. 2018;28:548–9.CrossRefGoogle Scholar
  7. 7.
    Eilenberg M, Langer FB, Beer A, et al. Significant liver-related morbidity after bariatric surgery and its reversal-a case series. Obes Surg. 2018;28:812–9.CrossRefGoogle Scholar
  8. 8.
    Tsai J-H, Ferrell LD, Tan V, et al. Aggressive non-alcoholic steatohepatitis following rapid weight loss and/or malnutrition. Mod Pathol. 2017;30:834–42.CrossRefGoogle Scholar
  9. 9.
    Lazzati A, Iannelli A, Schneck A-S, et al. Bariatric surgery and liver transplantation: a systematic review a new frontier for bariatric surgery. Obes Surg. 2015;25:134–42.CrossRefGoogle Scholar
  10. 10.
    Golse N, Bucur PO, Ciacio O, et al. A new definition of sarcopenia in patients with cirrhosis undergoing liver transplantation. Liver Transpl. 2017;23:143–54.CrossRefGoogle Scholar
  11. 11.
    Mazurak VC, Tandon P, Montano-Loza AJ. Nutrition and the transplant candidate. Liver Transpl. 2017;23:1451–64.CrossRefGoogle Scholar
  12. 12.
    Zaveri H, Dallal RM, Cottam D, et al. Indications and operative outcomes of gastric bypass reversal. Obes Surg. 2016;26:2285–90.CrossRefGoogle Scholar
  13. 13.
    Moon RC, Frommelt A, Teixeira AF, et al. Indications and outcomes of reversal of Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2014.Google Scholar
  14. 14.
    Chousleb E, Patel S, Szomstein S, et al. Reasons and operative outcomes after reversal of gastric bypass and jejunoileal bypass. Obes Surg. 2012;22:1611–6.CrossRefGoogle Scholar
  15. 15.
    Dapri G, Cadière GB, Himpens J. Laparoscopic reconversion of Roux-en-Y gastric bypass to original anatomy: technique and preliminary outcomes. Obes Surg. 2011;21:1289–95.CrossRefGoogle Scholar
  16. 16.
    Vilallonga R, van de Vrande S, Himpens J. Laparoscopic reversal of Roux-en-Y gastric bypass into normal anatomy with or without sleeve gastrectomy. Surg Endosc. 2013;27:4640–8.CrossRefGoogle Scholar
  17. 17.
    Campos GM, Ziemelis M, Paparodis R, et al. Laparoscopic reversal of Roux-en-Y gastric bypass: technique and utility for treatment of endocrine complications. Surg Obes Relat Dis. 2014;10:36–43.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Digestive SurgeryGénérale de Santé (GDS), Clinique Geoffroy-Saint HilaireParisFrance
  2. 2.Department of Digestive Surgery, Hepatobiliary Surgery and Liver TransplantationUniversity Hospital of ToursToursFrance
  3. 3.Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Metabolic Surgery, Avicenne University Hospital, Centre intégré Nord Francilien de la prise en charge de l’Obésité (CINFO)Université Paris XIII-UFR SMBH « Léonard de Vinci »BobignyFrance

Personalised recommendations